1326120601 NPI number — DR. BARRY RUBIN M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326120601 NPI number — DR. BARRY RUBIN M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

RUBIN

Provider First Name:

BARRY

Provider Middle Name:

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1326120601

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

02/11/2022

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

46 ROUTE 25A

Provider Second Line Business Mailing Address:

SUTIE 4

Provider Business Mailing Address City Name:

SETAUKET

Provider Business Mailing Address State Name:

NY

Provider Business Mailing Address Postal Code:

11733-2820

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

631-246-9501

Provider Business Mailing Address Fax Number:

631-246-9570

Provider First Line Business Practice Location Address:

635 BELLE TERRE RD STE 209B

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

PORT JEFFERSON

Provider Business Practice Location Address State Name:

NY

Provider Business Practice Location Address Postal Code:

11777-1935

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

631-246-9501

Provider Business Practice Location Address Fax Number:

631-246-9570

Provider Enumeration Date:

10/19/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 208100000X , with the licence number:  169794-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 911050 . This is a "PHS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 10173 . This is a "ANTHEM #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: P-34032414 . This is a "MULTIPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 10514507 . This is a "CAQH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 27313 . This is a "MASTER CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: P383718 . This is a "OXFORD PROVIDER#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 76235 . This is a "VYTRA PROVIDER #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 250010334 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 1078638000 . This is a "DEPT OF LABOR" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 205383 . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 4330561 . This is a "AETNA PIN #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: CIGNA . This is a "43165004" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".